Is health-care reform popular?

It's pretty common for Republicans to say that health-care reform is wildly unpopular. It's not even untrue. But nor is it true, exactly. Rather, it depends on the numbers you look at, and how you interpret those numbers.

I want to show you two graphs charting the popularity of health-care reform. The first summarizes the Republican position. It's a chart from Pollster.com tallying surveys asking whether you support or oppose the health-care reform bill.

Unpopular, right? The second chart summarizes the Democratic position on this question: It tallies recent responses to polls asking about the component pieces of the health-care bill:

Popular!

Health-care reform is unpopular. But if you actually tell people what's in the health-care reform bill, then it becomes quite popular. A recent Newsweek poll found the same thing: "The majority of Americans are opposed to President Obama's health-care reform plan — until they learn the details."

You can spin this information in a lot of different directions: The GOP has mounted a huge disinformation campaign. People are stupid. The polls are biased in one direction or another. The media covers conflict and ignores substance. Pick your favorite.

Here's how I understand this information: Voters don't pay very close attention to politics, and they pay even less attention to policy. Making the problem worse, the outlets that should inform them don't actually do so: The news focuses on conflict and points of interest, and also what's changing each day, which is, almost by definition, not the most popular parts of the bill. And don't just blame the media for that: It's what audiences want.

Another important contributor to voter opinions is their perception of the political process. If all Democrats and all Republicans harmoniously agreed on a piece of legislation, well, it's probably a pretty good piece of legislation, right? But if the process is relentlessly angry and partisan, there's more natural mistrust of the product. This would be fine if it was actually an accurate way of assessing the content of legislation, but it's really not. It's an accurate way of figuring out whether the opposition party is interested in winning the next election.

They also take their cues from politicians. This is similarly useless. As a thought experiment, imagine that George W. Bush, who proposed the Medicare Prescription Drug Benefit, had also proposed this health-care reform bill. It's actually pretty plausible: The two had fairly similar structures. But in that scenario, many Republicans would have supported the legislation as an effort to bring free market principles to universal health care, and many Democrats would have opposed it.

In the end, I don't think public opinion is very useful here. The quality of information that the public has routine access to is simply too low. That goes for the evidence that supports both sides: Would the public still support financing health care for poor people if they were told the system's costs were growing faster than their wages? Would they oppose the bill if they knew it was the most modest, conservative, universal health-care legislation a president has ever proposed, or that Democrats have included literally hundreds of Republican amendments?

It's pretty easy to make a poll respondent change their mind on something. You don't even have to ask a different question. Studies have shown a substantial impact simply from asking whether a survey-taker wants to take another moment and think it through. We who have access to better information, though, need to be doing a better job getting it out there.

I think size and scope (or apparent size and scope) plays a role here. If someone asks you if you'd like to remodel your kitchen, you might say yes. Then they ask, well, would you like to remodel the bathroom? Well, of course. What about organize your closets and your garage? Well, that sounds good, too. And how about we redo your bedrooms and put up siding and recarpet? Um, okay, that sounds good--

Then out comes a big contract with dozens up dozens of subsections and lots of legalese. and all the construction people are at the door with the supplies and your neighbor points to the crane right behind the construction people and says, "You know they're about to tear down your house, don't you? You know that's what you just agreed to, right?"

They are all there to remodel your house and make it more energy efficient and a better place to live, but you freak out, and tell them to go away.

I think the apparent ambitions of the bill, and the apparent size, was really a problem. Even if 2000 government pages reduces down to 600 regular people pages.

And though all those items listed may be popular--financial help for low and middle income folks, deficit reduction--the devil is in the details. If they think the financial help for low and middle income folks is going to come from slashing Social Security or from increasing their taxes 10%, it might not be so popular. If they are told the deficit reduction is going to come from privatizing Medicare, their opinions might change. There is a lot of information out there, dealing with specifics of how this stuff is accomplished, that might turn off some people to the entire bill, even if they supports it's core parts in principle.

And there are plenty of people against HCR because they just think it's anemic, that it isn't the single payer or public option we really need.

Even with them, they might like those specific things, but there would always be a "but". Sure, the individual mandate is great. But for HCR to be great, it needs a public option. Sure, insuring poor people is great, but that needs to be done through single payer, not some political slight of hand. And so on.

"But if you actually tell people what's in the health-care reform bill...."

You mean like the accounting trick to hide the costs? Like the Medicare cuts? Like all the "unnecessary" care that would be eliminated? Like how if you like the plan you currently have, you can't necessarily keep it.

Basically, if you tell people what the bill really *costs*, it gets less popular -- fast.

Free lunches are always popular, Ezra. But this one's expensive. And if the debate has shown anything, it's that liberals are very reluctant to admit how this bill really works, and what it will really cost. After all, to them those prices are worth paying.

How liberal healthcare works, by a well-known liberal:
http://www.youtube.com/watch?v=IT7Y0TOBuG4

"The news focuses on conflict and points of interest, and also what's changing each day, which is, almost by definition, not the most popular parts of the bill. And don't just blame the media for that: It's what audiences want."

Weird. I hear that a lot. But at some point, the media is self-selecting their audience with this assertion. Some of us don't want that, so we stop paying attention to the media outlets that focus on that. I, for one, read this blog because I don't want that, and this blog has a little less of that. Yes, I'm using myself as anecdotal evidence. But if I told a media person that I didn't want that, they would tell me that I, in fact, do want that but that I just don't know it. So, the cycle continues.

But I digress...your point that we don't know anything...yeah it's true. But it doesn't help that when we want to know something, it's really, really hard to find it out.

Reviewing these findings in the wake of the discussion of the jobs bill suggests that the lesson is to proceed incrementally, passing narrowly-focused bill after narrowly-focused bill, rather than try to swallow everything at once.

"We who have access to better information, though, need to be doing a better job getting it out there."

THe problem is Ezra there's no mandate that requires individuals to read your blog on a regular basis. Even if the government put that mandate in I'm sure the penalty would be a measly pittance that wouldn't effect real change.

And as you say you don't even have to change the words, you could change the emphasis, change the person saying those words and you could change the outcome.

I love listening lately to C-span but what I'll say is those shows like Washington Journal and the callers that call in are extremely partisan. I'm not sure if it has always been that way but it sure seems so now. They don't have to tell you anymore if you're calling from the Democratic or Republican line. You can tell by their question or comment. Its really partisan and really sad, just like most of the comments around here.

Just once I'd like to hear a conservative say: "We need to do something to take care of these folks".

Or a liberal say: "You're right, we are taxed too much and we do have to rein in spending somewhat"

I'd argue that is IS possible to focus "on conflict and points of interest, and also what's changing each day," thereby delivering "what audiences want" while still disseminating necessary information. There's nothing wrong with challenging points of conflict -- and it can be interesting.

Fact and civility actually make arguments more interesting: see, for example, the debate between R. Reagan and W. F. Buckley, Jr. -- two who had substantial disagreement but somehow charmed audiences. Similarly, Justice Sandra O'Connor describes dinner table arguments as the basis for her (notably mainstream and notably non-partisan) deliberative style.

Conversely, loss of civility seems to follow loss of fact: when one side in an argument begins to rely upon clouded, misleading fact and personal attacks, the other side follows and the process degenerates.

@visionbrkr: "Just once I'd like to hear a conservative say: 'We need to do something to take care of these folks'. Or a liberal say: 'You're right, we are taxed too much and we do have to rein in spending somewhat'"

I see you're still on the Pequod (Democratic party) as Captain Ahab (Pres. Obama) sails for Moby Dick (ObamaCare).

The "problem" is not a failure to communicate. The "problem" is that we're not stupid. This latest interation of ObamaCare is a tweak of the same old Rube-Goldberg-on-steroids monstrosity the previous versions were.

"Haven't heard a liberal saying anything about how we're taxed too much. They do talk about spending, however."

Liberals talk a lot about poor and middle class people taxes being too high. We use the term "regressive tax". But yes, we think the wealthiest among us in this country are undertaxed. And a lot of us do think the wealth in this country is shockingly consolidated. To our general detriment.

Ditto what kevin_willis said. From the SAME POLL Ezra uses to show how popular the disparate elements of health care legislation are, comes the conclusion:

"Overall, 32 percent hope Congress will send some version of the House and Senate’s comprehensive overhaul legislation to the president"

So yeah, remodelling the kitchen sounds great. And the bathroom really could use some sprucing up. Or maybe the garage could be converted. But then again, adding on a room could really be wonderful. But to get it all at once, you have to move out of the house for 3 months, deal with contractors and city inspectors and fine print and, oh did I mention THE COST?

The Democratic "position", as Ezra describes it, isn't reality-based. Everyone knows that there is broad bipartisan support for "health care reform" in the abstract. And that it is even possible to identify specific reforms that enjoy public support - especially when the reforms are spun as costless benefits rather than trade-offs. But once the specifics of a reform bill are laid out and it's possible to identify (monetary and non-monetary) costs, popular support tends to plummet.

The Republican "position" on the popularity of the reform bills recognizes that they are more than the sum of their cherry-picked parts.

I think public opinion polls are useful for precisely what they measure; that is what the public is thinking. If the components of the bill are individually popular but the larger package is not then I agree with you, that there are some issues there with the opposition disinformation campaign, the media, people being disengaged from politics, etc. But leaders focus on what they can change, not what they can't. What can be changed is the way that these things are presented to the public. Barack Obama has done a masterful job in his big speeches but the Dems and the White House have not convinced people how this reform fits in with the larger effort to give people economic security and provide basic fairness to people who work hard but get screwed by this very inefficient system. I don't mean to take shots at people who I know are working hard to sell make this stuff happen, but at some point it has to be acknowledged that a) people don't understand why the reform is needed; b) people don't realize how they will benefit personally; c) people don't understand why reform is so, so controversial in DC. People who don't follow politics accept that where there's smoke, thre's fire. The Dems always needed a plan on how to characterize Republican opposition to this. To many in the public, Republican opposition appears related to a failure of bipartisanship, a bad thing. People also don't understand the whole 60 vote thing. If they've gotten 60 votes before, why can't they now? must be somethin wrong with that health care bill. Add to this the fact that many of the president's core supporters are utterly disgusted by the process and bam, you've got a big political/public opinion problem.

Obama has done a terrible job in explaining his program. And, when analyzing the individual parts, if the question is phrased to include federal oversight on your healthcare, the favorable rate would go down. The fact is, despite some good aspects, the overall plan has been overshadowed by the spector of the big, bad feds telling me what I can and cannot do. That is where Obama has failed miserably!

At this point I wish the Democratic Party had rolled out each of these reforms as individual bills. Start with the issues that have the most broad support, least cost, simplest to explain. Get them passed one by one.

Heck, you could even start with the issues the Republicans say they like the most, such as tort reform (so the GOP could have something to point to as a victory for their constituents, so they could maybe relax a bit of their posturing and obstructionism).

I do understand that many of the issues are interdependent, so if some passed while others didn't, it wouldn't work. But at least it would be so much clearer *why* they are all needed together.

This is exactly the same thing that happened when Clinton proposed health care reform. The Republicans lied and muddied the waters sufficiently that when the people were given the plan without Clinton's name attached something like 75% were in favor. When they were given the plan with Clinton's name attached, support dropped in half

Health care reform is popular, the Obama/Reid bill is widely unpopular. This is partly because many progressives believe the bill is weak, inadequate and unfair in many ways. To a greater extent, unfortunately, most conservatives and Republicans will oppose any major health care bill because they simply don't care about ordinary people, especially the needy and poor.

Mr. Klein though does not cite any poll data on how people might think about the following: the inadequate subsidies for most people in the middle class, the penalties for not buying insurance, the significant reductions in Medicare spending, delaying most of the limited reforms until 2014, the lack of a public option, leaving twenty some million people without health care insurance, how this bill accompanied by an Obama/Democratic amnesty bill, if passed, will allow millions of currently illegal immigrants to attain health care coverage, many with government subsidies, while many citizens, permanent residents are left out, etc.

It's what audiences want (but not this much) largely because they aren't compensated for the enormous positive benefits they bring to 300 million Americans and 6 billion human beings, besides themselves, by becoming better informed and voting better.

It's a classic externality issue. But one of monumental size and importance. Thus, of course it should be dealt with in the long established way in economics, by government subsidization.

Ezra, I hope you looked at my three parter on this. Some evidence it's worth your while: all three were featured in Mark Thoma's links at:

Today we got another strong demonstration of the importance of this with ABC announcing layoffs of 25% of the news staff.

A lot of poor unsubstantive journalism is NOT because it's what people want anyway. A very large part of it is because good substantive research, investigation, fact checking, expert staffing, etc. is a lot more expensive than he said--she said, horse race, personality journalism. And it's not subsidized so that anything close to it's true value is reflected in the profit equation of major media outlets, which are almost all for-profit.

I'm not being condascending but do the poor really pay that much if anything at all in taxes (obviously dependent on how poor they are). I have relatives that we bail out from time to time so that they don't get foreclosed on and they don't work, could work, but are too lazy to work. Now obviously that's a single example and a worst case scenario and the overwhelming majority of poor can't work due to illness, injury or lack of work even for trying to find it but I know from their examples that they don't pay much in taxes at all.

I don't profess to know the tax rates (others have posted them on here) but I don't see the poor being overburdened with taxes and i guess if you're going to say middle class I'm guessing it depends on each of our expectations of what the middle class (and more importantly their income level) is.

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I guess you are unaware that Obama has lowered taxes on Americans making under $250k?

Or don't those people count?

Posted by: Patrick_M | February 23, 2010 6:09 PM | Report abuse

Patrick,

I fall well below that threshold above you mention and you know what, I don't feel LESS taxed, I feel more. Now when I file my taxes shortly maybe I'll be pleasantly surprised but I doubt it. Its interesting though how you conveniently forget all the extra taxes in the healthcare bill to come that will fall evenly on whoever uses healthcare in the US including the poor and middle class (although some of those will be subsidized for their care so they won't feel it at all). Just another shell game.

The only place I feel less taxed is in my home state when I see examples like this. God, I LOVE Chris Christie.

Ezra, you've said on numerous occasions that if only people knew what was in Obamacare they'd overwhelming support it. In other words most of the U.S. population are like stupid children and like children they sometimes have to be forced into something they don't like for their own good. I have a couple of problems with this poll you cite that shows how all these elements of Obamacare are actually really popular.

First, who prepared the poll? An independent non partisian pollster or a Democratic leaning pollster? It doesn't say.

Second, how about including aspects of Obamacare that are sure to be unpopular like taxing "cadillac" insurance plans, paying fines and possibly going to jail if you don't buy insurance, cutting $500 billion out of Medicare, mandating a government insurance package, detailing just how many new government agencies and bureacrats will be created to administer Obamacare, detailing all the new taxes not just the ones on the "rich", how about telling people that they realistically won't necessarily get to keep their present doctor, mentioning that after its all said and done Obamacare still doesn't get everyone covered with Medical insurance.

Poll those questions Ezra and then tell me how popular Obamacare really is.

It is perfectly reasonable to favor the components of a bill in principle yet oppose the bill itself on the grounds that the components are not adequately covered by the actual provisions of the bill. In other words, many who tell pollsters they oppose the bill do so because the bill is not liberal enough.

"And don't just blame the media for that: it's what audiences want."
But there's the rub. You are placators, not educators, because unlike decades gone by, your profession responds to a bottom line. That will prostitute the best of intentions.